SummarySixty ASA 1 and 2 children aged between 2 and 16 years who required tracheal intubation as part of anaesthesia for elective surgery were studied. We evaluated intubating conditions, haemodynamic responses and duration of apnoea following propofol 4 mg.kg )1 combined with either remifentanil 1.25 lg.kg )1 (group R), or suxamethonium 1 mg.kg )1 (group S). Tracheal intubation was graded as excellent, good or poor according to ease of laryngoscopy, vocal cord position, coughing, and jaw relaxation and limb movement. Thirty of group S and 28 of group R children were successfully intubated on the first attempt. Overall, intubation conditions were excellent or good in 26 ⁄ 30 (87%) patients in group S and 20 ⁄ 30 (67%) in group R (p < 0.05). Mean apnoea time was 190 s in group S, and 362 s in group R (p < 0.001). Heart rate increased in response to suxamethonium (p < 0.01) and both systolic and diastolic blood pressure decreased in the remifentanil group (p < 0.01).

Background National Registries are essential to direct current practice. Rheumatoid arthritis (RA) registries in the middle east and North Africa remain scarcely represented. Objective To describe a population of Saudi RA patients and to compare the findings to internationally reported data. Methods This is an observational study that was conducted at Doctor Soliman Fakeeh Hospital (DSFH) in Saudi Arabia. The study ran from 2014 to 2018 using a pool of 433 patients. Inclusion criteria included adults older than 18 years of age who fulfilled the 2010 American College of Rheumatology criteria for the diagnosis of RA and who were also regular visitors in our rheumatology clinics. Data were collected directly from patients and entered in a specially designed program. Results At initial presentation, 45.5% had demonstrated active disease (moderate or high disease activity) based on DAS-28-CRP scores, while 54.5% were in low disease activity or remission. The remission rates after 1 year had increased to 79.6% (345 patients), while 9.7% (42 patients) and 10.6% (46 patients) had low disease activity and moderate disease activity, respectively. It was also found that the female gender, higher Health Assessment Questionnaire-Disability Index (HAQ-DI) and longer lag1/lag2 periods were associated with higher disease activity in our population. Conclusion We detected higher remission rates at 1 year of follow-up. This could be attributed to many factors, including good referral systems with easier access to biologics. We aim to expand this registry to the national level.

Background Pharmacokinetics (PK), efficacy, and safety of the opioid analgesic tapentadol in the treatment of moderate-to-severe acute pain have so far not been investigated in pediatric patients <2 years of age. Patients and Methods Two multicenter, open-label trials assessed the pharmacokinetic profile, safety, tolerability, and efficacy of single doses of tapentadol oral solution (OS; NCT02221674; n=19) or intravenous infusion (IV, EudraCT 2014-002259-24; n=38) in children from birth to <2 years of age. Of these, 8 preterm neonates were included in the IV trial. A third randomized, double-blind, placebo-controlled trial (NCT02081391) investigated the efficacy and safety of multiple tapentadol OS doses in patients from birth to <2 years (placebo n=4, tapentadol n=11) using an immediate rescue trial design. Patients in all three trials underwent surgery that, in the investigator’s opinion, reliably produced moderate-to-severe pain requiring opioid treatment. Results Administration of single tapentadol doses resulted in tapentadol serum concentrations within the targeted range known to be safe and efficacious in adults and compared well to the range observed for children aged 2 to <18 years. Pain intensity already improved 15 min after administration. In the multiple dose trial, amounts of supplemental opioid analgesic medication within the first 24 h after start of trial medication were low (placebo 0.02 mg/kg, tapentadol 0.05 mg/kg). All patients stopped treatment with the trial medication because opioid analgesics were no longer required. Treatment-emergent adverse events occurred in 42.1% (tapentadol OS single dose), 28.9% (tapentadol IV), and 75% of placebo and 54.5% of tapentadol patients (tapentadol OS multiple doses), none of them serious. Conclusion Tapentadol showed a favorable PK and safety profile in children <2 years of age. Multiple tapentadol OS dosing is efficacious and generally well tolerated in children ≥2 years and might also be a useful treatment option for children <2 years in need of strong analgesics.

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Background: Since the first case of SARS-CoV 2 has been reported from Wuhan China back in December 2019, the virus has spread all over the world and has so far infected more than 35 million humans and led to more than one million deaths woldwide. We describe in this paper the clinical characteristics and outcome of PCR confirmed Covid 19 patients that were admitted to a tertiary care hospital in Saudi Arabia. Methods: Retrospective review of patients that had positive PCR on nasopharyngeal swab for SARS Cov2 and that were admitted and discharged from a tertiary care hospital in the city of Jeddah, Saudi Arabia between March and July 2020. Epidemiological, demographic, and clinical data were collected. The clinical course of patients was reviewed. Risk factors for involvement of lower respiratory tract (Pneumonia), for need for ICU and for death were analyzed. Results: The records of total of 395 patients were reviewed. 15% of Covid 19 patients in our population were completely asymptomatic, one quarter of which had abnormalities on chest imaging. Among the patients with one or more Covid 19 symptoms, 75% had lower respiratory tract involvement and one quarter had normal chest imaging. One third of all patients developed leukopenia and around 2 thirds had lymphocytopenia. Thrombocytopenia was not common (occurred in 15%), 29% of our patients had CRP>10 and 25.1% had elevated ALT (not exceeding 5 times upper normal). Nine percent of our patients needed ICU admission, 3.8% needed mechanical ventilation. 9 patients (2.3%) in our population died. Advancing age, increasing BMI, and smoking history were significantly associated with increased mortality. Developing abnormalities on chest imaging (Pneumonia) was significantly associated with increasing BMI, advancing age, not receiving BCG vaccination at birth, history of smoking and presence of co-morbidities (p value less 0.05 with all these variables). Blood group and presence of co-morbidities was significantly associated with need for ICU care but not with mortality. In our population neither ethnicity, nor gender, had significant association with hospital course or outcome, and no one younger than 45 years and no one with BMI less than 24 died. Conclusion: Advancing age, increasing BMI and history of smoking were found to be significant risk factors for mortality in our population. History of Bacille calmette Guerin (BCG) vaccination was significantly associated with less involvement of lower respiratory tract but had no significant association with final outcome. Asymptomatic Covid 19 is more of a silent active infection rather than a silent inactive carrier state.